48 hours in the belly of the healthcare beast--with "a hot colon"
(Editor’s note: This post isn’t about prostate cancer. But some of the experiences may be relevant for any of you admitted to the hospital for any reason. I was admitted to a community hospital last Friday with “a hot colon.” As it is, I was in the same hospital where I might have undergone a prostatectomy if I hadn’t said “no” to unnecessary surgery in 2010 from “Dr. R.P.” I was happy to learn that the urologist involved now offers active surveillance. So things have been evolving. Good news. I started blogging my story in Facebook last week to chronicle my time in the belly of the beast of the U.S. healthcare system. If you’re interested, you can read more there.)
(In the ER.)
By Howard Wolinsky
“Inside the belly of the beast”
Chapter 3: “Surviving another day, with more questions than answers.”
I entered the maw last Friday with a suspicious CT scan. I slogged through the U.S. healthcare system for 48 hours and emerged on the other side on Sunday after a weekend in Club Med.
I was still alive, grateful, and ready to live another day. But I had more questions than answers.
I had experienced left quadrant abdominal pain since last Monday. I ignored the pain to help my wife Judi successfully get through a medical procedure on Tuesday.
I couldn’t deny my pain anymore on Wednesday. It felt like diverticulosis, a common problem caused by too little fiber in the diet. Sacs in the colon are inflamed and are at risk for a serious infection. I have been dealing with this on and off for maybe 20 years.
I managed with sleight of hand to get a consult on Wednesday and a recommended CT on Friday. No openings were available for a matter of weeks or months. But I know how to play the system.
Still, everything seems more difficult to achieve these days. An MD appointment. A CT scan Getting a prescription filled.
Soon after I got home after the CT I had wrangled, the telemed doc called--I needed to get to the ER. STAT.
He said I had a “hot colon” that should command the rapt attention of ER staff and doctors. In reality? Not really. No doubt they had sicker patients in the house.
And to complicate things, the hospital was understaffed and overworked. So the workers told me.
I believe it. With COVID. Health professional burnout. And with everything else going wrong, it’s harder to get tests done, see doctors, and even pick up a simple prescription for antibiotics. Is this our new reality and future in a sea of falling expectations? This has been the reality for generations in other communities.
I live in an affluent suburb--or so I’m told--surrounded by blue-collar and impoverished areas, some of the poorest suburban areas in the U.S. I spent the next two days with a cross-section of people from these communities. I was a rare old white guy in a sea of young, black and brown faces.
I signed into the ER in a small community hospital at about 1:30 p.m. It’s the closest hospital to our house.
After five hours, I reached the inner sanctum of the ER, and things were starting to pop.
They did an X-ray while I was on the ER bed.
I obtained the results Sunday online in the portal. At 6:15 pm, a radiologist found that the blockage had resolved. RESOLVED. Yet I went on to be admitted into the belly of the beast. A matter of precaution.
I was generally pleased with the care I received. But why in the world didn’t they tell me the blockage seen at 11 a.m. or so Friday was gone by 6:15 p.m. the same day?
If I were an anxious person, the uncertainty might have hit me hard. I might have had a huge release if I had been informed there was no blockage--so I wasn’t going to experience death of bowel tissue nor pain nor the risk of infections and death from a colon attack. It was a serious situation that could have been defused readily if they shared some information.
But I didn’t learn of this change of fortune until I spoke to the surgeon the next morning--16 hours later.
Meanwhile, I was subjected to a tug-of-info-war between the go-getter surfer ER cowboy with bleached (?) blonde hair who was telling me I might need an unpleasant nasogastric tube inserted or possibly surgery vs. the gray-haired wise woman hospitalist who said I should wait out the blockage. (She said the odds for surgical intervention were small--only 10% of patients like me require surgery.)
Listen to the women.
So I encountered the dilemma of the wise woman vs. the spring-into-action tiger. I was rooting of course for no intervention.
This scenario reminded me of the debate I faced when I was diagnosed 12 years ago with low-risk prostate cancer. A local surgeon told me he had good news and bad news for me. Bad: You have cancer, sir. Good: I have an opening in my OR next Tuesday and can “cure” your cancer.
I asked him about active surveillance of my cancer. He said he didn’t support the approach. Not uncommon in 2010, but the tables have turned there in the intervening years.
(Many surgeons these days don’t even consider what I have cancer. The urologist then blew me off when I asked about active surveillance--no active treatment, just monitoring the lesion. I did that at UChicago.
(Here’s an irony. I met a charming team of radiology techs in the hospital on Saturday. More wise women with comedy timing. My prostate situation came up. They knew the doctor I saw 12 years ago. They claimed he offers active surveillance now. Progress,)
So I spent the night with the usual hospital poking and prodding. I was disturbed when I got a roommate. He had been sent to the hospital from work when his blood sugar hit a mile-high 650-plus. The staff brought the blood sugar down to 150.
I was reassured somewhat to learn that everyone on the floor had passed a COVID test. But I really wanted privacy. My roomie was quiet and quickly vibrated out of my reality.
After hours of waiting--and blood draws and glucose tests (mine generally was excellent at 75-90 but did spike when I went on a low-fiber diet)--the doctors finally converged on me on Saturday morning.
A hospitalist. A surgeon. And a gastroenterologist, partner of the doctor who does my colonoscopies--a word the young ER doctor could barely pronounce.
Sounds like a lead into a joke. But I’ll skip that.
The hospitalist said they were going to keep observing me. He was amused at how relaxed I was, sprawled out on the hospital bed tapping on my laptop.
He deferred to the general surgeon, an imposing but friendly figure in a white lab coat. I could detect his easy smile through his KN-95 mask and a twinkle in his eyes.
First thing, he said was: “We’re not sharpening the knives.”
Whew. Good news.
He patted my hand and my shoulder. All bedside manner. He was a Latin charmer and knew it. I suppose the endorphins were dancing. The doctor was a real presence. A. natural. Reassuring. Suave.
I asked a few questions.
He said:
“The decision to operate is easy. The decision not to do surgery is difficult.”
He said: “You don’t need surgery.”
Whew again.
He knew something I didn’t. The blockage had been resolved, he said. A follow-up X-ray confirmed this again later in the day.
“We’re going to get you out of here,” he said. Today? I ask. He said maybe.
The GI specialist came by next. He looked like he was on his way from or to the garden center or hardware store. He stood some distance away from me. Well-spoken but formal.
He agreed with the surgeon. No need for intervention. He said the blockage wasn’t caused by anything I did or didn’t do, and he couldn’t recommend something to prevent it from happening again. Just one of those things.
I peppered him with “why” questions. Like I don’t drink as much water as I should. Was that the cause? He urged me to drink more water.
I should come to see him if something unusual needs to be explored.
And he was off to the endo lab--or the garden center.
I was ready to leave. I was taken off IV fluids. I had a liquid diet lunch and transitioned to a low-fiber dinner for gut rest.
I thought a final X-ray would be enough to free me. It wasn’t.
Getting out was easy to say. Hard to do. The hospitalist resisted release. He wanted more observation. The staff kept taking vitals and drawing blood.
I spent a day alone, catching up with “Good Cop,” an Israeli comedy, on Netflix and laughing. I did some writing.
The hospitalist early Sunday said he was letting me go. I was more than ready. He said to follow up with the family doctor. I have a video visit on Wednesday.
I am puzzled by why I had pain on the left side--not diverticulosis—but X-rays showed trouble on the right side. Why was there a blockage? Was it a referred pain? How long was the blockage there? Could rehydration to infinity have unblocked it instantly?
Why wasn’t I told that the blockage was gone 16 hours earlier? Is anyone in that situation ever updated? I don’t consider that concierge service. Just a humane touch.
I had a small fever (101)--why did that happen? A radiologist friend—I was getting unofficial second opinions from my hospital bed— suggested that a virus might have caused my gastric distress, and he said that the nausea was grounds enough to warrant admission and observation. No one explained that to me, and I had few opportunities to ask
Hours passed, and finally, I was wheeled out to freedom.
Just another day in the U.S. healthcare system. Someone else’s turn now
My ride.
Active Surveillance 101 - Part 2 featuring Nancy and Larry White and Dr. Laurence Klotz at ASPI on Oct 29, 2022 12:00 PM in
Register at https://bit.ly/3SENBAd
To view session 1 go to https://bit.ly/3BUCxIE featuring Nancy and Larry White and Steve Spann, MD, family physician and dean of the University of Houston College of Medicine.
Moving AS to the next level: Can we help more patients?
The Active Surveillance Coalition, a collaboration of leading support groups for active surveillance (AS) for prostate cancer, is sponsoring a webinar at 9 a.m. Vancouver/12 p.m. New York/5 p.m. London/6 p.m. Amsterdam on Thursday, Nov. 17 to discuss how we can move the needle on AS, close monitoring of prostate cancer.
AS leaders from Sweden, Holland, the United Kingdom, and the state of Michigan’s will share their “secret sauce” for reaching AS rates of near 90% and above.
The free webinar is entitled “Moving AS to the next level: Can we help more patients?”
Register here:
https://zoom.us/meeting/register/tJAscuGspjMrH9LYgdTYDjmM4vvRadtnwsQM